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Screening can reduce fracture rate

The Government started its term with such a huge breadth and depth of policies. Spending has been exponentially increasing in the NHS as we zoom past the £77 billion mark.

A resurgent NHS has seen some initial improvement, but the expectation lags behind the dream. Flagships such as electronic booking and practice commissioning have been proposed to rid the health sector of its woes.

Word is about that the Department of Health has run out of ideas. These flagship policy big pictures just don't fit in the same gallery.

Cosy forums are taking place to try to exchange ideas to get things back on track. For example, commissioning has been given a new impetus. All GPs will be required to climb aboard by December 2006. Rumours are circulating that bribing GPs with cash for locums is the only way to control costs.

Practice commissioning is about limiting costs. Conversely, Labour is trumpeting a patient-led NHS with choice and primary care reform. These only serve to drive cost and demand. But cost and demand are the real issues that we need to address. Did any of this feature in the election campaign? Of course not!

Crosshead

Like an impending MI, managers and GPs all have a sense of foreboding about health care. Several things have gone wrong all at once. First, just about every PCT in the land is strapped for cash and has overspent. There is a huge drive to get the books balanced. To give you a guide as to the magnitude of this task, the NHS needs to claw back £500 million, at a time when most budgets are cantering yet further into the red.

Second, PCTs are about to be forcibly merged, with a ratio of two to four becoming one. Managers simply have no appetite for reform; they are worrying about jobs, family and mortgages. What is worse is that the most able are voting with their feet and finding alternate employment. This seems to be the start of a talent drain the NHS can ill afford.

The price for this chaos could threaten the continued existence of Bevan's NHS. Private providers, competition for services, dual registration and co-payments are an increasing reality, not a political aspiration. There must have come a point on the Titanic when it was realised that shuffling deckchairs was not going to stop 53,147 tonnes of metal sinking to the bottom of the sea.

Practise-based commissioning is no different. Last-gasp attempts are being made to get PCTs' budgets back into line.

Recalcitrance among GPs towards yet further enforced reform is not about to change.

Feel free to climb aboard if you want to add ‘deckchair shuffler' to your CV.